Hydroxyurea: Brands, Price & Uses in Bangladesh

Hydroxyurea is an antimetabolite (ribonucleotide reductase inhibitor) with the following evidence-based indications:

Established / FDA-approved uses

• Sickle cell disease (SCD): Reduces the frequency of painful vaso-occlusive crises and the need for blood transfusions in adults and children with SCD, primarily by inducing fetal hemoglobin (HbF) production.
• Chronic myeloid leukemia (CML): Used for cytoreduction, particularly during the initial control of leukocyte counts before or alongside definitive therapy.
• Essential thrombocythemia and polycythemia vera: Used to reduce platelet or red cell counts and thrombotic risk in these myeloproliferative disorders, especially in high-risk patients.

Guideline-supported / combination uses

• Locally advanced squamous cell carcinoma of the head and neck and carcinoma of the cervix: Used as part of combination regimens with radiation therapy; not effective as monotherapy for these indications.

Off-label uses (commonly reported, not FDA-approved)

• Refractory psoriasis (second-line, when standard therapies fail).
• Selected myeloproliferative neoplasms and hypereosinophilic syndromes, under specialist supervision.

Use of Hydroxyurea should always be directed and monitored by a qualified physician, typically a hematologist or oncologist.

Sickle Cell Disease (Adults and Pediatric ≥ 2 years)

Chronic Myeloid Leukemia

Typically 20-30 mg/kg/day as a single daily dose, adjusted according to leukocyte counts and response; continuous monitoring required.

Essential Thrombocythemia / Polycythemia Vera

Initial dosing individualized (commonly around 15-20 mg/kg/day), titrated to target platelet or hematocrit levels under specialist guidance.

Head and Neck / Cervical Cancer (combination therapy)

Dosed per specific combination chemoradiation protocols; refer to the treating oncologist's regimen.

Renal Impairment

Dose reduction is required in patients with significant renal impairment (e.g., creatinine clearance below 60 mL/min); consult a physician for individualized dose adjustment and closer monitoring.

Hepatic Impairment

Use with caution; dose adjustment may be needed, particularly in severe hepatic impairment, though formal dosing guidelines are limited.

General Administration

Hydroxyurea should be taken exactly as prescribed by a physician, at the same time each day, with or without food, and swallowed whole with water (capsules should not be opened, chewed, or crushed due to the risk of exposure to cytotoxic powder). Do not stop, extend, skip doses, or share this medicine with others without medical advice; regular blood count monitoring is essential throughout treatment.

Boxed warnings associated with Hydroxyurea include myelosuppression, secondary leukemia risk, cutaneous vasculitic toxicities, and embryo-fetal toxicity (detailed further under Precautions and Warnings, and Pregnancy and Lactation).

Common side effects

• Myelosuppression (leukopenia, anemia, thrombocytopenia) - the most common dose-limiting effect
• Macrocytosis (usually a benign, expected finding rather than a sign of vitamin deficiency)
• Gastrointestinal disturbances: nausea, vomiting, diarrhea, constipation, stomatitis
• Skin changes: rash, hyperpigmentation, scaling, alopecia, and dryness
• Headache and fever

Less common but serious effects

• Cutaneous vasculitic ulcerations and, rarely, gangrene (see Precautions and Warnings)
• Secondary skin malignancies with long-term use
• Secondary leukemia with prolonged therapy in myeloproliferative disease
• Pulmonary toxicity (interstitial lung disease) - rare

Patients should promptly report unusual bruising, bleeding, fever, skin ulcers, or persistent illness to their physician.